Medical implement for manipulating sutures particularly useful in arthroscopic surgery

ABSTRACT

A medical implement for transport of a suture shuttle, comprising a handle including a proximal portion configured for manual gripping by a user, a distal portion, an internal passageway for a suture shuttle, extending between a proximal end and a distal end of the handle; an intermediate portion formed with a thumb depression facing a first direction; the proximal portion comprising a slot extending from the internal passageway to a lateral face of the handle for enabling side-loading of a suture shuttle into a proximal portion of the internal passageway, the slot facing a second direction; the slot extending longitudinally from a proximal end of the handle to an intersection with the thumb depression, wherein at the intersection the slot is exposed in the first direction, and a roller rotatably mounted at the thumb depression.

RELATED APPLICATIONS

This application is a continuation of U.S. patent application Ser. No.13/201,867 filed on Aug. 17, 2011, which is a National Phase of PCTPatent Application No. PCT/IL2010/000140 having International filingdate of Feb. 17, 2010, which claims the benefit of priority of U.S.Provisional Patent Application No. 61/152,980 filed on Feb. 17, 2009.The contents of the above applications are all incorporated by referenceas if fully set forth herein in their entirety.

FIELD AND BACKGROUND OF THE INVENTION

The present invention relates to a medical implement for manipulatingsutures. The invention is particularly useful in arthroscopic surgery orother minimally invasive surgery, and is therefore described below withrespect to such an application.

In minimally invasive surgery, such as arthroscopic surgery, alloperations must be performed through a narrow opening, the size of whichlimits the size of the instruments used and the free space available tomanipulate them. Small-size cutting, grasping, debriding and stitchinginstruments, capable of operating through small portals, have beendeveloped for this purpose.

Internal suturing is necessary in many arthroscopic procedures, in orderto close wounds, repair tissue tears, or to reattach tissue whichbecomes detached from its normal position. A strand of suture must beapplied to the location to be sutured, and the suture must then bepassed through a layer of tissue and retrieved from the exit side. Inother cases sutures attached to an anchoring element must be capturedand passed through tissue.

Many suture passing and stitching devices are available to thearthroscopist. For example, U.S. Pat. No. 5,499,991, U.S. Pat. No.5,222,977, as well as catalogs of Linvatec-Concept Inc., Arthrex Inc.,DePuy Mitek Inc. and others describe and advertise such devices. Allthese devices are limited either to a part of the functions necessary,or in directions of approach, or in maneuverability in limited space.

OBJECTS AND BRIEF SUMMARY OF THE INVENTION

An object of the present invention is to provide a medical implementparticularly useful in arthroscopic surgery and having advantages in oneor more of the above respects.

According to a broad aspect of the present invention, there is provideda medical implement particularly useful in arthroscopic sutures,comprising:

-   -   a handle having a proximal end configured for manual gripping by        a user, a distal end, an internal passageway extending between        the proximal end and the distal end, and an intermediate portion        formed with a recess extending from the outer surface to the        internal passageway;    -   a shuttle movable through the passageway and having an exposed        intermediate portion within the recess for manipulation by a        user gripping the handle, and a suture-receiving-element at its        distal movable axially through the distal end of the handle;    -   and a roller rotatably mounted to the handle underlying the        exposed intermediate portion of the shuttle such that, after a        suture has been received by the suture-receiving-element of the        shuttle, a user, gripping the handle, may manipulate the shuttle        with respect to the distal end of the handle by thumb-pressing        the exposed portion of the shuttle against the roller and        rotating the roller.

In the preferred embodiment of the invention described below, theimplement further comprises a shaft having a proximal end joined to thedistal end of the handle, a distal end formed with a pointed tip forpiercing tissue, and a passageway from its proximal end to its distalend for receiving the movable shuttle.

According to further features in the described preferred embodiment, theshuttle includes a long flexible wire having a proximal end extendingoutwardly of the proximal end of the handle, and a distal end formedwith a loop defining the suture-receiving-element. The long flexiblewire of the shuttle includes two strands formed at its distal end withthe loop.

According to still further features in the described preferredembodiment, the handle is further formed with a slot having alongitudinally-extending section extending along one side of the handleand terminating in a transversely-extending section adjacent to therecess in the handle and spaced therefore in the proximal direction; theslot communicating with the internal passageway through the handle topermit side-loading of the shuttle through the handle.

In addition, the transversely-extending section of the slot terminatesin a proximally-extending notch effective to center the shuttle withrespect to the handle, and therefore also with respect to the recesstherein and to overlie the central area of the roller underlying therecess.

As will be described more particularly below, such a medical instrumentis particularly useful in arthroscopic surgery wherein all operationsmust be performed through a narrow opening.

BRIEF DESCRIPTION OF THE SEVERAL VIEWS OF THE DRAWING(S)

The invention is herein described, by way of example only, withreference to the accompanying drawings, wherein

FIG. 1 is a perspective view of one preferred embodiment of a medicalsuture passing implement constructed according to the present inventionfor use in suturing within the shoulder;

FIG. 2 is a top view of the implement of FIG. 1;

FIG. 3 is an enlarged fragmentary view of a portion of FIG. 2;

FIG. 4 is a sectional view along line V-V′ in FIG. 2;

FIG. 5 is an enlarged view of the distal end of the medical implement ofFIG. 1, and particularly the wire loop projecting from the tip at thedistal end;

FIGS. 6A, 6B, 6C, 6D, 6E, 6F and 6G are alternative configurations ofthe distal tip of the implement shown in FIG. 4; and

FIGS. 7A-7D illustrate the method of loading the implement with a longflexible wire formed at its distal end with a loop for receiving asuture to be passed through tissue.

It is to be understood that the foregoing drawings, and the descriptionbelow, are provided primarily for purposes of facilitating understandingthe conceptual aspects of the invention and possible embodimentsthereof, including what is presently considered to be a preferredembodiment. In the interest of clarity and brevity, no attempt is madeto provide more details than necessary to enable one skilled in the art,using routine skill and design, to understand and practice the describedinvention. It is to be further understood that the embodiments describedare for purposes of example only, and that the invention is capable ofbeing embodied in other forms and applications than described herein.

DESCRIPTION OF A PREFERRED EMBODIMENT Overall Construction

The medical implement illustrated in FIGS. 1-5 of the drawings, andtherein generally designated 2, includes three main parts: a handle 10having a proximal end 11 configured for manually grasping and a distalend 12; an elongated shaft 20 having a proximal end 21 joined to thedistal end 12 of the handle, and a distal end formed with a pointed tip22 for piercing tissue; and a long flexible wire 30 receivable within,and manually moveable through, an interior passageway 13 (FIG. 4) of thehandle 10 and elongated shaft 20.

The long flexible wire 30 constitutes a shuttle for manipulating asuture, as will be disclosed more particularly below. It consists of twotwisted strands having a proximal end 31 extending outwardly of theproximal end 11 of handle 10; a distal end twisted at its tip to form aloop 32 for receiving the suture to be passed through the tissue; and anintermediate portion 33 (FIG. 3) exposed for manual engagement by thethumb of user gripping the handle in order to extend or retract thedistal loop 32.

As shown particularly in FIGS. 3 and 4, handle 10 is formed, adjacentits distal end 12, with a recess 14 extending along the outer surface ofthe handle towards, but terminating short of, the distal end 12 of thehandle. Recess 14 also extends inwardly from the outer surface to thepassageway 13 through the handle receiving the long flexible wire 30 soas to expose the intermediate portion 33 of the wire to the thumb of theuser grasping the handle.

In addition, the implement further includes a roller 15 rotatablymounted at 15 a to the handle so as to underlie the exposed intermediateportion 33 of the long flexible wire 30 received within passageway 13 ofthe handle. Preferably, the outer surface of roller 15 is knurled orribbed or is made of an elastomeric material, to enable the user, bypressing the exposed wire portion 33 against the roller, to rotate theroller in either direction in order to move the wire 30, particularlyits distal loop 32, outwardly from the elongated shaft 20 to extend thedistal loop, or inwardly into the elongated shaft to retract the distalloop. As shown particularly in FIG. 3, handle 10 is further formed witha slot 16 having a longitudinally-extending section 16 a extending alongone side of the handle and terminating in a transversely-extendingsection 16 b adjacent to recess 14 in the handle and spaced therefrom inthe proximal direction. The longitudinally-extending section 16 a ofslot 16 extends from the proximal end 11 of handle 10 to thetransversely-extending section 16 b at the proximal side of recess 14.Slot 16 communicates with the interior passageway 13 of handle 10 so asto permit side loading of the long flexible wire 30 through the handleand through the elongated shaft 20. The transversely-extending section16 b of slot 16 terminates in a proximally-extending notch 16 ceffective to center wire 30 with respect to the handle, and thereforealso with respect to its recess 14 and to overlie the central area ofroller 15 underlying the recess.

It will thus be seen that the proximal side of notch 15 c communicateswith the portion of internal passageway 13, between the transverse slotsection 16 b and the distal end of the handle, via an opening 13 a atthe proximal end of the notch. It will also be seen that the distal sideof recess 14 communicates with the portion of passageway 13 between therecess and the distal end of the handle via an opening 13 b.

Use and Operation

The manner of loading the implement with the long flexible wire 30, andof using the implement for passing sutures through tissue, will now bedescribed, particularly with reference to FIGS. 7a -7 c.

Thus, as shown in FIG. 7a , the loop 32 at the distal end of theflexible wire 30 is inserted into opening 13 b of passageway 13 at thedistal side of the recess 14 to overlie the roller 15. The wire is thenmanually advanced distally through the passageway, and through theelongated shaft 20, by thumb pressing the intermediate portion 33 of thewire against roller 15, while moving the thumb in order to advance thewire within the hollow shaft 20. The user then, with one hand, pressesthe wire against roller 15 in order to temporarily immobilize the wire,while the other hand side-loads the proximal end of the wire into thesection of the interior passageway 13 between slot section 16 b and theproximal end of the handle. This is done by passing the proximal end ofthe wire through the longitudinal slot section 16 a into thetransversely-extending slot section 16 b, and then into notch 16 c ofthe slot terminating in opening 13 b. The notch centers the wire withrespect to the handle recess 14 and the roller 15 underlying the recess(FIG. 7b ), while the proximal end of the wire extends through theproximal end of the passageway 13 in the handle 10 (FIG. 7c ).

The implement is thus loaded (FIG. 7d ) such that thumb-pressing portion33 of the wire, exposed in recess 14, and moving the thumb forwardlywill project the distal loop 32 of the wire outwardly of elongated shaft20, while moving the thumb in the opposite direction will retract theloop within the elongated shaft.

When the illustrated implement is used for passing a suture throughtissue, the implement is inserted through a portal at the surgical site;and the tissue to be sutured is then pierced with the sharp distal tip22 (FIG. 5) of the elongated shaft 20. The wire is then advanced byrotating roller 15, while the intermediate wire portion 33 is pressedagainst the outer surface of the roller, until loop 32 of the distal tipprotrudes outwardly of the sharpened tip 22 of shaft 20, as shown inFIG. 5.

A suture manipulating device may then be used to thread the suture intothe loop 32. When this is done, the wire is then retracted into theshaft 20 until the suture is held against the distal end of the shaft.The distal end of shaft 20, with the suture held to it, is then passedthrough the tissue.

The implement, with the suture held to the distal tip of the shaft 20,may then be passed through the portal to the outside, and the suturefreed from the loop for knotting. Alternatively, once the suture ispassed through the tissue, the suture may be released from theimplement, by releasing the pressure applied against portion 14 of thewire, to remove the implement from the suture, if so convenient to thesurgeon.

Some Variations

FIGS. 6a-6g illustrate various helical, corkscrew, or other curvedarrangements, shown at 22 a-22 g respectively, that may be formed at thedistal end of the elongated shaft 20 in order to facilitate piercing oftissue at any relative orientation to the elongated shaft when insertedvia the portal opening into the patient's body. Such variations in thedistal sharpened tip of the elongated shaft may be provided in a set ofimplements constructed with such distal tips, or may be included asattachments to the distal end of the elongated shaft.

While the invention has been described with respect to one preferredembodiment, it will be appreciated that this is set forth merely forpurposes of example, and that many other variations, modifications andapplications of the invention may be made.

What is claimed is:
 1. A medical implement for transport of a sutureshuttle, comprising: a handle comprising: a proximal portion configuredfor manual gripping by a user, a distal portion, an internal passagewayfor a suture shuttle, extending between a proximal end and a distal endof said handle; an intermediate portion formed with a thumb depressionfacing a first direction; said proximal portion comprising a slotextending from said internal passageway to a lateral face of said handlefor enabling side-loading of a suture shuttle into a proximal portion ofsaid internal passageway, said slot facing a second direction; said slotextending longitudinally from a proximal end of said handle to anintersection with said thumb depression, wherein at said intersectionsaid slot is exposed in said first direction; a roller rotatably mountedat said thumb depression, the roller being mounted such that when asuture shuttle is loaded into said internal passageway, the thumb of auser gripping the handle at said depression may press an exposed portionof said suture shuttle against the roller.
 2. The medical implementaccording to claim 1, wherein a notch is defined at said intersection,said notch effective to center a loaded suture shuttle with respect tosaid handle and with respect to said roller.
 3. The medical implementaccording to claim 1, wherein said thumb depression defines a concaverecess in said handle.
 4. The medical implement according to claim 1,wherein when said handle is gripped by a user, said first directioncomprises a direction facing the user's thumb.
 5. The medical implementaccording to claim 1, wherein said second direction is substantiallyperpendicular to said first direction.
 6. The medical implementaccording to claim 1, wherein said roller is rotatable in distal andproximal directions to transport a suture shuttle held against itaxially so as to advance or retract a suture-receiving element of saidsuture shuttle.
 7. The medical implement according to claim 1, whereinan outer surface of said roller is knurled or ribbed.
 8. The medicalimplement according to claim 1, wherein a distal end of said handlecomprises a pointed tip.
 9. The medical implement according to claim 1,wherein an outer surface of said roller comprises an elastomericmaterial.
 10. The medical implement according to claim 1, wherein adistal end of said handle comprises a helically shaped tip or acorkscrew shaped tip.
 11. The medical implement according to claim 1,wherein said handle is sized to be inserted, at least in part, through aport at a surgical site.
 12. The medical implement according to claim 1,wherein an outer surface of said handle at said intermediate portioncomprises one or more protrusions.
 13. The medical implement accordingto claim 1, wherein only a part of an outer surface of said roller isexposed at said thumb depression.
 14. A kit comprising: a medicalimplement a handle comprising: a proximal portion configured for manualgripping by a user, a distal portion, an internal passageway for asuture shuttle, extending between a proximal end and a distal end ofsaid handle; an intermediate portion formed with a thumb depressionfacing a first direction; said proximal portion comprising a slotextending from said internal passageway to a lateral face of said handlefor enabling side-loading of a suture shuttle into a proximal portion ofsaid internal passageway, said slot facing a second direction; said slotextending longitudinally from a proximal end of said handle to anintersection with said thumb depression, wherein at said intersectionsaid slot is exposed in said first direction; a roller rotatably mountedat said thumb depression, the roller being mounted such that when asuture shuttle is loaded into said internal passageway, the thumb of auser gripping the handle at said depression may press an exposed portionof said suture shuttle against the roller; and a suture shuttlecomprising a suture-receiving element at a distal end of said shuttle.15. The kit according to claim 14, wherein said suture receiving elementis loop shaped.
 16. The kit according to claim 14, wherein said sutureshuttle comprises a flexible wire including two twisted strands.
 17. Amethod of transporting a suture shuttle using a medical implementcomprising: a handle comprising: a proximal portion configured formanual gripping by a user, a distal portion, an internal passageway fora suture shuttle, extending between a proximal end and a distal end ofsaid handle; an intermediate portion formed with a thumb depressionfacing a first direction; said proximal portion comprising a slotextending from said internal passageway to a lateral face of said handlefor enabling side-loading of a suture shuttle into a proximal portion ofsaid internal passageway, said slot facing a second direction; said slotextending longitudinally from a proximal end of said handle to anintersection with said thumb depression, wherein at said intersectionsaid slot is exposed in said first direction; a roller rotatably mountedat said thumb depression; said method comprising: inserting a distal endof said suture shuttle into said internal passageway at said thumbdepression to overlie said roller; thumb pressing said suture shuttleagainst said roller and moving the thumb to advance said wire into adistal portion of said internal passageway; pressing said suture shuttleagainst said roller to temporarily immobilize said shuttle whileside-loading a proximal portion of said shuttle onto said proximalportion of said handle through said slot; moving said roller totransport said suture shuttle axially to advance or retract asuture-receiving element of said suture shuttle.
 18. The methodaccording to claim 17, further comprising, prior to said inserting,piercing a tissue to be sutured using a distal end of said handle. 19.The method according to claim 17, further comprising threading a sutureonto said suture receiving element of said shuttle, and retracting saidshuttle until said suture is held against said distal end of saidhandle.
 20. The method according to claim 17, wherein said side-loadingcomprises inserting said proximal portion of said shuttle in a distal toproximal direction into said slot.